Fast genotypic detection of drug resistance mutations in the HIV-1 reverse transcriptase gene of treatment-naive patients

Objectives: This study was performed to assess the frequency of drug resistance mutations in treatment-naive HIV-1-infected patients. Study Design/Methods: Frozen plasma samples from 135 treatment-naive HIV-infected adults were available from the first time the patients were seen for their infection in our center between 1992 and 1997. A rapid genotypic assay based on reverse DNA hybridization (LiPA HIV-1 RT, Murex, London, U.K.) was used to study substitutions at reverse transcriptase (RT) codons 41, 69, 70, 74, 184, and 215. Additionally, a selective polymerase chain reaction (PCR) for the multiple dideoxynucleoside resistance (MddNR) mutation Q151M was performed. Results: 16 patients (12%) harbored virus with one or more drug resistance mutations. The prevalence of patients with drug-resistant virus was 0% in 1992, 17% in 1993, 0% in 1994 (only 6 samples tested), 18% in 1995, 14% in 1996, and 9% in 1997. Mutation K70R (resistance to zidovudine) was found in 8 patients, M41L (resistance to zidovudine) in 5 patients, M184V/I (resistance to ddI/ddC/3TC) in 2 patients, and T215Y/F (resistance to zidovudine) in 4 patients. All samples were wild type at codons 69 (ddC), 74 (ddI), and 151 (MddNR). Conclusions: Virus strains containing drug resistance mutations are now found in about 1 of 10 treatment-naive HIV-1-seropositive patients in Luxembourg. We believe that testing for drug-resistant virus before starting treatment should be recommended and will help to improve the selection of the most effective antiretroviral treatment. We also suggest the need for an international surveillance program on HIV drug resistance in treatment-naive patients.